N端脑钠肽前体检测在早产儿动脉导管未闭诊治中的价值

Value of N-terminal pro-brain natriuretic peptide detection in diagnosis and treatment of patent ductus arteriosis in premature infants

目的探讨N端脑钠肽前体检测评估在早产儿动脉导管未闭诊治中的价值。方法选取2012年10月-2015年4月入住该院的患有心力衰竭的233例早产儿为研究对象,所有患儿在出生24 h内行超声心动图检查,其中动脉导管未闭患儿46例为实验组,分为症状性动脉导管未闭组和非症状性动脉导管未闭组;症状性动脉导管未闭早产儿又分为动脉导管未闭治疗组和动脉导管未闭未治疗组;动脉导管闭合早产儿187例为对照组。测定所有研究对象出生后第1、3、7天的N端脑钠肽前体水平,实验组使用布洛芬进行治疗,比较治疗前后的N端脑钠肽前体水平。结果实验组治疗前超声心动图显示动脉导管未闭内径2~2.5 mm、2.5~5.0 mm所占比例分别为76.09%、23.91%,导管未闭率(100.00%)高于治疗后动脉导管未闭率(6.52%),差异有统计学意义(P<0.05)。症状性动脉导管未闭组早产儿血N-端脑钠肽前体水平明显高于非症状性动脉导管未闭组和对照组(P<0.05),非症状性动脉导管未闭组早产儿血N-端脑钠肽前体水平明显高于对照组(P<0.05);症状性动脉导管未闭组、非症状性动脉导管未闭组和对照组第7天早产儿血N-端脑钠肽前体水平均低于第3天(P<0.05)。动脉导管未闭治疗组早产儿第7天血N-端脑钠肽前体水平明显低于第3天(P<0.05);第7天动脉导管未闭治疗组早产儿血N-端脑钠肽前体水平明显低于动脉导管未闭未治疗组(P<0.05)。结论由早产儿动脉导管未闭导致的血流动力学改变在发展与治疗过程中与N端脑钠肽前体水平变化有良好的相关性,在诊断与治疗中具有重要作用。

Objective To explore the value of N-terminal pro-brain natriuretic peptide（ NT-pro BNP） detection and evaluation in diagnosis and treatment of patent ductus arteriosis（ PDA） in premature infants. Methods A total of 286 premature infants with heart failure were selected from the hospital from Octomber 2010 to April 2015,echocardiography examination was carried out within 24 hours after birth,46 premature infants with PDA（ experimental group） were divided into symptomatic PDA group and asymptomatic PDA group; the premature infants in symptomatic PDA group were divided into PDA treatment group and PDA non-treatment group; 187 premature infants without PDA were designed as control group. NT-pro BNP levels on the first,the third and the seventh days after birth among all the premature infants were detected. The premature infants in experimental group were treated by ibuprofen. NT-pro BNP levels before and after treatment were compared. Results Echocardiography examination showed that the internal diameter of patent duct before treatment in experimental group was 2-2. 5 mm,the proportions of premature infants with internal diameter of patent duct 2. 5- 5. 0 mm accounted for 76. 09% and23. 91%,respectively. The incidence rate of PDA before treatment was 100. 00%,which was statistically significantly higher than that after treatment（ 6. 52%）（ P〈0. 05）. The level of NT-pro BNP in symptomatic PDA group was statistically significantly higher than those in asymptomatic PDA group and control group（ P〈0. 05）,the level of NT- pro BNP in asymptomatic PDA group was statistically significantly higher than that in control group（ P〈0. 05）. The levels of NT-pro BNP on the seventh day in symptomatic PDA group,asymptomatic PDA group and control group were statistically significantly lower than those on the third day（ P〈0. 05）. In PDA treatment group,the level of NT-pro BNP on the seventh day was statistically significantly lower than that on the third day（ P〈0. 05）. On the seventh day,the level of NT-pro BNP in PDA treatment group was statistically significantly lower than that in PDA non-treatment group（ P〈0. 05）. Conclusion NT-pro BNP-induced hemodynamic changes are correlated with NT-pro BNP in the process of development and treatment in premature infants,which plays an important role in diagnosis and treatment of PDA.